eMedicine Specialties > Physical Medicine and Rehabilitation > Upper Limb Musculoskeletal Conditions
De Quervain Tenosynovitis
Updated: Dec 15, 2009
Introduction
Background
De Quervain's tenosynovitis (or de Quervain tenosynovitis) is caused by stenosing tenosynovitis of the first dorsal compartment of the wrist. The first dorsal compartment at the wrist includes the tendons of the abductor pollicis longus (APL) and the extensor pollicis brevis (EPB). Patients with this condition usually report pain at the dorsolateral aspect of the wrist, with referral of pain toward the thumb and/or the lateral forearm. This condition responds well to nonsurgical treatment.1,2,3,4,5,6 (See images below and Images 1-2.)
The first dorsal compartment of the wrist includes the tendon sheath that encloses the abductor pollicis longus and the extensor pollicis brevis tendons at the lateral border of the anatomic snuffbox.
The Finkelstein test is performed by having the patient make a fist with the thumb inside the fingers. The clinician then applies ulnar deviation of the wrist to reproduce the presenting symptoms of dorsolateral wrist pain.
Pathophysiology
In the first dorsal compartment of the wrist, a tendon sheath encloses the abductor pollicis longus and the extensor pollicis brevis tendons at the lateral border of the anatomical snuffbox. Inflammation at this site commonly is seen in patients who use their hands and thumbs in a repetitive fashion. Thus, de Quervain's tenosynovitis can result from cumulative (repetitive) microtrauma. Inflammation also may occur after an isolated episode of acute trauma to the site.6
Frequency
United States
De Quervain's tenosynovitis is relatively prevalent, especially among individuals who perform repetitive activities using their hands (eg, certain assembly line workers, secretaries).7
Mortality/Morbidity
Mortality is not associated with de Quervain's tenosynovitis. Some morbidity may result as the patient experiences progressive pain, with limitations occurring in activities requiring use of the affected hand.
Race
No race predilection exists for de Quervain's tenosynovitis.
Sex
Although this condition is commonly seen in females and males, the incidence of de Quervain's tenosynovitis appears to be significantly greater in women.6 Some sources even quote a female-to-male ratio as high as 8:1. Interestingly, many women suffer from de Quervain's tenosynovitis during pregnancy or the postpartum period.8
Age
De Quervain's tenosynovitis is much more common in adults than in children.
Clinical
History
Patients with de Quervain's tenosynovitis typically report localized pain at the dorsolateral aspect of the wrist.
- Occasionally, a patient's history may indicate isolated, acute trauma to the involved site.
- More commonly, the history includes chronic, repetitive activities using the involved hand or thumb.
- Inquire about specific repetitive activities that may have contributed to the onset of symptoms. Examples include work activities (eg, computer use, materials handling) or recreational activities (eg, knitting, golf, racket sports).
- A thorough understanding of the ergonomics of precipitating activities contributes to making an accurate diagnosis and forms the basis for necessary ergonomic interventions.
- Ask how the patient's symptoms limit the patient's ability to perform vocational or avocational activities.
Physical
The most classic finding in de Quervain's tenosynovitis is a positive Finkelstein test.
- Perform the Finkelstein test by having the patient make a fist with the thumb inside the fingers. The clinician then applies passive ulnar deviation of the wrist to reproduce the chief complaint of dorsolateral wrist pain.
- Perform the Finkelstein test bilaterally to compare the involved side with the uninvolved one.9
- Carefully access the first carpometacarpal (CMC) joint, since pathology at this site can cause a false-positive Finkelstein test.
- Look for swelling at the first dorsal compartment of the wrist.
- Sensory examination specifically includes careful evaluation in distributions of the median and radial nerves, since either of these could cause pain/dysesthesias radiating into the thumb.
- Because cervical radiculopathy also can cause thumb pain/dysesthesias, evaluation includes assessment for upper limb strength, muscle stretch reflexes, sensation, and provocative neck maneuvers (eg, the Spurling test to assess for cervical root impingement).
- Because some cases of dorsolateral forearm pain are caused by lateral epicondylitis, evaluate for point tenderness in the region of the lateral epicondyle, at the elbow.
- In some cases, de Quervain's tenosynovitis may be associated with rheumatoid arthritis; therefore, assess the hands for rheumatologic deformities and malalignment.
Causes
Minor cumulative (ie, repetitive) trauma commonly contributes to the development of de Quervain's tenosynovitis. Activities that may cause repetitive trauma to the wrist include factory work, secretarial duties, golfing, or racket sport playing.
Isolated acute trauma also may contribute to the development of de Quervain's tenosynovitis. In addition, the disorder may occur in association with rheumatoid arthritis.
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 Overview: De Quervain Tenosynovitis |
| Differential Diagnoses & Workup: De Quervain Tenosynovitis |
| Treatment & Medication: De Quervain Tenosynovitis |
| Follow-up: De Quervain Tenosynovitis |
| Multimedia: De Quervain Tenosynovitis |
| References |
| Further Reading |
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References
Breen TF. Wrist and hand. In: Steinberg GG, Akins CM, Baran DT. Orthopaedics in Primary Care. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:99-138.
Brinker MR, Miller MD. The adult wrist. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:179-95.
McGee DJ. Forearm, wrist, and hand. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:198-215.
Snider RK. Hand and wrist. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:160-263.
Strakowski JA, Wiand JW, Johnson EW. Upper limb musculoskeletal pain syndromes. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:756-82.
Ilyas AM, Ast M, Schaffer AA, et al. De quervain tenosynovitis of the wrist. J Am Acad Orthop Surg. Dec 2007;15(12):757-64. [Medline].
Wolf JM, Sturdivant RX, Owens BD. Incidence of de Quervain's tenosynovitis in a young, active population. J Hand Surg Am. Jan 2009;34(1):112-5. [Medline].
Schned ES. DeQuervain tenosynovitis in pregnant and postpartum women. Obstet Gynecol. Sep 1986;68(3):411-4. [Medline].
Forget N, Piotte F, Arsenault J, et al. Bilateral thumb's active range of motion and strength in de Quervain's disease: comparison with a normal sample. J Hand Ther. Jul-Sep 2008;21(3):276-84; quiz 285. [Medline].
Batteson R, Hammond A, Burke F, et al. The de Quervain's screening tool: validity and reliability of a measure to support clinical diagnosis and management. Musculoskeletal Care. Sep 2008;6(3):168-80. [Medline].
Hanlon DP, Luellen JR. Intersection syndrome: a case report and review of the literature. J Emerg Med. Nov-Dec 1999;17(6):969-71. [Medline].
Glajchen N, Schweitzer M. MRI features in de Quervain's tenosynovitis of the wrist. Skeletal Radiol. Jan 1996;25(1):63-5. [Medline].
Diop AN, Ba-Diop S, Sane JC, et al. [Role of US in the management of de Quervain's tenosynovitis: review of 22 cases]. J Radiol. Sep 2008;89(9 Pt 1):1081-4. [Medline].
Lennard TA. Fundamentals of procedural care. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:1-13.
Robson AJ, See MS, Ellis H. Applied anatomy of the superficial branch of the radial nerve. Clin Anat. Jan 2008;21(1):38-45. [Medline].
Scheller A, Schuh R, Honle W, et al. Long-term results of surgical release of de Quervain's stenosing tenosynovitis. Int Orthop. Oct 2009;33(5):1301-3. [Medline].
Richie CA 3rd, Briner WW Jr. Corticosteroid injection for treatment of de Quervain's tenosynovitis: a pooled quantitative literature evaluation. J Am Board Fam Pract. Mar-Apr 2003;16(2):102-6. [Medline]. [Full Text].
Geiringer SR. Tendon sheath and insertion injections. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:44-8.
Goldfarb CA, Gelberman RH, McKeon K, et al. Extra-articular steroid injection: early patient response and the incidence of flare reaction. J Hand Surg [Am]. Dec 2007;32(10):1513-20. [Medline].
Sawaizumi T, Nanno M, Ito H. De Quervain's disease: efficacy of intra-sheath triamcinolone injection. Int Orthop. Apr 2007;31(2):265-8. [Medline]. [Full Text].
Apimonbutr P, Budhraja N. Suprafibrous injection with corticosteroid in de Quervain's disease. J Med Assoc Thai. Mar 2003;86(3):232-7. [Medline].
Chodoroff G, Honet JC. Cheiralgia paresthetica and linear atrophy as a complication of local steroid injection. Arch Phys Med Rehabil. Sep 1985;66(9):637-9. [Medline].
Green SM. Nonsteroidal anti-inflammatories. In: Tarascon Pocket Pharmacopoeia 2000. Loma Linda, Calif: Tarascon Pub; 2000:2000:11-2.
Further Reading
Clinical guidelines:
Diagnostic imaging guideline for musculoskeletal complaints in adults - an evidence-based approach. Part 2: upper extremity disorders. Canadian Protective Chiropractic Association - Professional Association
l'Université du Québec à Trois-Rivières - Academic Institution. 2008 Jan. 31 pages. NGC:006702
Forearm, wrist, & hand (acute & chronic), not including carpal tunnel syndrome. Work Loss Data Institute - Public For Profit Organization. 2004 (revised 2008 May 29). 128 pages. NGC:006557
Clinical trials:
A Clinical Trial of Splinting for DeQuervain's Tenosynovitis
Keywords
de Quervain tenosynovitis, tenosynovitis, de Quervain's tenosynovitis, Quervain's tenosynovitis, quervain tenosynovitis, stenosing tenosynovitis, de Quervain's disease, Quervain disease, de Quervain disease, abductor pollicis, extensor pollicis, abductor pollicis longus, extensor pollicis brevis, pollicis longus, pollicis brevis
